Chief Inspector of Hospitals recommends Worcestershire Acute Hospitals NHS Trust should be placed into special measures

England's Chief Inspector of Hospitals has recommended Worcestershire Acute Hospitals NHS Trust should be placed into special measures after a Care Quality Commission inspection rated the trust as Inadequate overall.

Following inspections carried out in July, CQC inspectors found the trust, which provides acute healthcare services to approximately half a million people living in Worcestershire, needed to make urgent improvements in a number of areas to ensure it was consistently delivering care which was safe, effective, caring, and responsive to people’s needs in services that are well-led.

Inspectors had concerns about the trust’s staffing in a number of areas, resulting in an over reliance on temporary staff. There were particular concerns relating to the provision of medical staff in some services and an over reliance on locum doctors putting extra strain on some services.

In the emergency department, consultant cover did not meet with the Royal College of Emergency Medicine’s workforce recommendations. Overcrowding in this area was an on-going risk. Actions taken to improve the way patients are received at the hospital and how they move between hospital services had reduced the time patients waited for initial assessment but waiting times were still not meeting national standards.

Although the executive team had undergone recent significant change, with the majority of executive directors in interim positions and many being new to the organisation in the recent weeks and months, it demonstrated an understanding of and commitment to addressing the issues the trust was facing.

However, inspectors found the lack of stability at board level to be of significant concern when considering issues that required addressing.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“We found a number of serious problems when we inspected the services run by Worcestershire Acute Hospitals NHS Trust and I have made a recommendation to the Trust Development Authority that the trust should be placed into special measures.

“We made the TDA aware of our concerns following the inspection and it has begun to work with the trust to make sure these are appropriately addressed and that progress is monitored.

“My inspection team found that the majority of staff were hard working, passionate and caring but had to struggle against the pressures they faced. We found that staff treated patients with dignity and respect which is why we rated the trust as Good for caring. We found the caring approach to patients in maternity and gynaecology to be outstanding and good practice was also noted in the critical care unit, end of life service, surgery and in medical care.

“One of the reasons we rated the trust as Inadequate for being well-led and safe was because when things went wrong they were not investigated promptly or thoroughly and there was a lack of learning from these incidents to prevent patient harm in the future. This was particularly the case in the maternity and gynaecology service.

“While the trust had a vision and a set of values these were not well embedded or understood by staff. The way some divisional teams were run was not effective.

“The trust has been receiving support from an improvement director from the TDA and this was seen as having a positive impact and was valued by the executives inspectors spoke with.

“The trust managers have told us they have listened to our inspectors’ findings and have begun to take action where it is required. We have maintained close contact with the trust since the inspection and will undertake further inspections, including unannounced visits to check that the necessary improvements have been made.”

The inspection highlighted a number of concerns and areas where the trust must improve, including:

• The trust must ensure there are sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of patients including carrying out daily ward rounds.
• Risk assessments must be completed and used effectively to prevent avoidable harm, for example to stop patients developing pressure ulcers.
• The trust must ensure that patients’ nutrition and hydration are fully assessed, recorded and acted upon promptly if necessary.
• A robust system must be developed to ensure children and young people with mental health needs are suitably risk assessed when admitted to services to ensure the care and support meets their needs.

Despite the overall rating of Inadequate, inspectors identified a number of areas of Outstanding practice across the trust, including:

• There was an outstanding patient observation chart used within the critical care unit. This chart was regularly reviewed and updated.
• In the maternity and gynaecology services, inspectors were told by women using the service that staff were consistently compassionate and caring. Women reported being treated with respect and dignity and having their privacy respected at all times.
• Inspectors observed exceptional care in the early morning while visiting Avon 4 Ward at Worcester Royal Hospital. The staff approach to patients was extremely respectful, compassionate and caring. The atmosphere on the ward at this early hour was relaxed and calm with appropriate low levels of lighting and staff speaking quietly to ensure patients were not disturbed.
• The critical care team provided an outstanding example of compassion to a patient with a learning disability.

An inspection team, including doctors, nurses, midwives, hospital managers, trained members of the public, a variety of specialists, CQC inspectors and analysts spent six days at the trust in July. The trust was rated as Inadequate for being safe and well-led, rated Requires Improvement for being effective and responsive and rated Good for being caring. The maternity and gynaecology services were rated Outstanding for being caring.

The inspection was carried out between14 and 17 July 2015 as part of our comprehensive inspection programme. Unannounced inspections were also carried out at Worcester Royal Hospital on 26 and 27 July and at the Alexandra Hospital on 26 July.

Worcestershire Acute Hospitals NHS Trust provides services from four sites: Worcester Royal Hospital, Alexandra Hospital, Kidderminster Hospital and Treatment Centre and surgical services at Evesham Community Hospital, which is run by Worcestershire Health and Care NHS Trust.

Full reports including ratings of all core services will be published on the CQC website on Wednesday, 2 December.

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